Utilization Management Representative I – Backoffice Support

• Reviews and processes utilization management requests received through fax, electronic queues, and other approved channels.

• Accurately enters referral and authorization information into utilization management systems.

• Prepares and sends clear, complete, and accurate fax correspondence to providers, facilities, members, and internal partners.

• Meets departmental productivity, quality, accuracy, and turnaround-time standards while maintaining a low error rate.

• Reviews documentation for completeness and refers cases requiring clinical review to the appropriate clinical reviewer.

• Verifies benefits and administrative requirements within the scope of the role.

• Documents all actions and correspondence accurately and completely.

• Demonstrates accountability and ownership of assigned workload by monitoring queues, prioritizing tasks, following work through completion, and escalating barriers promptly.

• Protects confidential information and complies with HIPAA, privacy and security requirements, company policies, accreditation standards, contractual obligations, and applicable federal and state regulations.

• Identifies and reports potential quality, privacy, compliance, or regulatory concerns through established escalation processes.

• Performs other duties as assigned.

• Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

• Administrative support, healthcare operations, data entry, document processing, or back-office experience strongly preferred

• Medical terminology training and experience in medical or insurance field preferred

• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

• Ability to meet established productivity, quality, accuracy, compliance, and turnaround-time expectations preferred

• Ability to manage assigned work independently, maintain confidentiality, and follow detailed policies and procedures preferred

• Proficiency with computers, electronic work queues, email, and document-management systems preferred

• Experience processing faxes, referrals, authorizations, claims, medical records, or healthcare correspondence preferred

• Knowledge of HIPAA and healthcare privacy requirements preferred

• Experience working in a high-volume, production-based, compliance-focused environment preferred

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $15.96 to $23.94

Location(s): Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level:

Non-Management Non-Exempt